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Loren S. Jack, Charles Blake; Complications of Intravitreal Injections In A Resident VA Clinic. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1696.
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Perform a safety analysis of intravitreal (IVT) injections in a resident VA clinic by quantifying complications experienced over a 22 month period.
The computerized patient record system (CPRS) employed by the William Jennings Bryan Dorn Veteran’s Administration Medical Center was used to search for the CPT code used for IVT injections from 01/01/2008 through 10/31/2010. Only procedures performed by a resident were included. The procedure note and follow-up note were reviewed for complications. Sterile technique was used in all IVT injections, which included the use of sterile gloves, a sterile drape, prepping the periocular structures as well as the conjunctiva with 5% betadine solution, an eyelid speculum, pre-treatment and post-treatment moxifloxacin ophthalmic solution, and sterile lidocaine jelly for local anesthesia.
A total of 115 patients were identified and 297 injections were performed. There were 201 IVT Ranibizumab, 85 IVT Bevacizumab, and 11 IVT Triamcinolone injections included in the chart review. Complications not related to elevated post-treatment intraocular hypertension (PTIOH) from all injections combined for 7 episodes of subconjunctival hemorrhage, 1 episode of air bubbles injected into the eye, 1 episode of subconjunctival hematoma, and 1 episode of vitreous hemorrhage viewed immediately following IVT injection that resolved at the 3-week follow-up appointment. There were 10 complications (3.4%) experienced in 297 IVT injections not related to PTIOH. PTIOH, defined as an intraocular pressure >40 mmHg immediately following IVT injection, occurred in 12 patients. One patient required an anterior chamber paracentesis, however, the PTIOH resolved either with observation or pharmacologic pressure management in all but 3 patients (1%), defined as IOP >25 at the follow-up visit. Of note, no episodes of retinal detachment, endophthalmitis, pseudoendophtalmitis, or hypotony occurred.
IVT injections performed by residents are safe when performed under adequate supervision using sterile technique. Minor complications included PTIOH that resolved spontaneously or with conservative management, subconjunctival hemorrhage and hematoma. Major complications were rare with one episode of PTIOH requiring anterior chamber paracentesis and one episode of spontaneously resolving vitreous hemorrhage. No episodes of retinal detachment, endophathlmitis, pseudoendophthalmitis, or hypotony occurred.
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